The 3 C’s of Lung Cancer (Change, Collaboration, and Creation): Highlights of World Lung 2018

September 2018 ended with a bang! The 19th World Conference for Lung Cancer was hosted in Toronto, summer unofficially ended in New York, the U.S. Food and Drug Administration approved another drug, dacomitinib, for lung cancer … I am sure I am missing a few things.

This year’s World Conference on Lung Cancer (or World Lung, as it’s fondly referred to) was the biggest World Lung ever convened—over 7,000 delegates from 100 countries attended. More importantly, the meeting showcased a number of practice-changing scientific presentations—too many for me to just list. Therefore, I am going to try and categorize them into themes.

Change is on the horizon

Practice-changing science pertinent to the entire patient journey, from screening to treatment, was presented. As you all may be aware, lung cancer screening using low-dose computed tomography (LDCT) is available in the US to individuals at high risk of developing lung cancer. This is, however, not the case in Europe and other parts of the world. Results from the NELSON trial from Europe that were disclosed at the meeting will soon change this. This trial, which was set up to determine the benefits of LDCT for lung cancer screening, enrolled 15,792 patients and clearly demonstrated the benefit of CT screening to men at high risk for lung cancer. The benefit was even more pronounced in women. The study reinforces the population-level benefits of LDCT and also lays the groundwork for additional studies to look at gender differences in lung cancer.

In terms of lung cancer therapies, exciting news for ALK-positive lung cancer! A clinical trial with brigatinib, an ALK inhibitor that is currently approved for those patients who have progressed on crizotinib, shows that this drug works really well in the first-line setting–even for those patients who have brain metastases. Soon, ALK-positive lung cancer patients may have a new first-line treatment option.

LUNGevity Scientific Advisory Board member Dr. Scott Antonia presented updated results from the PACIFIC trial testing immunotherapy with chemotherapy and radiation (chemoradiation) for Stage III non-small lung cancer patients (NSCLC). The new results show that adding a checkpoint inhibitor, durvalumab, to chemoradiation provides a clear survival benefit to stage III NSCLC patients. This is big news, given that Stage III patients are a unique subset of NSCLC patients with very few treatment options.

Last but not least, small cell lung cancer (SCLC) may be scoring a big win. Results from the IMpower 133 clinical trial show that the addition of an immunotherapy drug, atezolizumab, to the standard chemotherapy regimen for SCLC is beneficial. The standard of care for SCLC has been chemotherapy for the past 30 years, so this is indeed a big deal!

Collaboration is the key to change

Of course, change isn’t possible without collaboration. Lung cancer is a complex disease that requires multiple stakeholders to be at the table to come up with solutions. The biggest impact of collaboration was highlighted by the oncogene-driven patient groups, such as the ROS1ders, ALK Positive, EGFResisters, RET Renegades, and Exon 20 mutation groups. Apart from providing support to patients and caregivers, and increasing awareness about the disease, such patient groups accelerate research by raising funds for research, helping patients enroll in oncogene-specific clinical trials, and providing tissue and biospecimens for creating new mouse models to study the unique subtype of lung cancer. As LUNGevity Scientific Advisory Board member Dr. David Carbone pointed out during his plenary talk “Science that matters!,” the first step to developing effective therapies is robust basic science—and development of mouse models to study these unique subtypes of lung cancer is the first phase in testing new drugs.

Creation of new therapies and treatment paradigms

The scientific community has also been hard at work creating new drugs for subsets of lung cancer that are hard to treat. One such subset is lung cancer that has mutations in exon 20 of the EGFR or HER2 genes. These mutations do not respond to the standard EGFR tyrosine kinase inhibitors. Work from Scientific Advisory Board member Dr. John Heymach shows that drugs such as poziotinib may be used for these rare subtypes of lung cancer. In addition, scientists are creating new drugs, such as entrectinib and ropotrectinib, for ROS1-positive lung cancer. These drugs are showing promise, both in patients who have been previously treated with crizotinib and those who have never received a ROS1 inhibitor.

I think LUNGevity Scientific Advisory Board member Dr. Julie Brahmer’s plenary presentation quote “No patient is left behind” is what we, as a community, should be striving for. I left this year’s World Lung feeling certain that we are taking a step in that direction.

Dr. Basu Roy is LUNGevity's Director of Translational Research Programs/Director of Patient FoRCe.

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